Individual ProviderAdaobi EzeanolueNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address1701 Bearden Dr, Ste 200, Las Vegas, NV 89106-4189(702) 310-9110PECOS EnrollmentBased on the most recent information from CMS, provider Adaobi Ezeanolue is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1275988115Provider TypeIndividualFull NameEzeanolue, AdaobiCredentialAPRNGenderFemaleSole ProprietorNoEnumeration Date4/28/2016Last Updated10/26/2020Contact InformationPractice LocationPractice Address1701 Bearden Dr, Ste 200, Las Vegas, NV 89106-4189Phone(702) 310-9110Fax(702) 310-9114Mailing LocationMailing Address1701 Bearden Dr, Ste 200, Las Vegas, NV 89106-4189Phone(702) 310-9110Fax(702) 310-9114Provider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicenseAPRN002189NevadaCode363LP0808XDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicenseAPRN002189Nevada